Hasil untuk "Medicine (General)"

A. Suchman, K. Markakis, H. Beckman et al.

M. Goddard, Peter C. Smith

Benjamin A Lipsky, A. Berendt, H. Deery et al.

Benjamin A. Lipsky, Anthony R. Berendt, H. Gunner Deery, John M. Embil, Warren S. Joseph, Adolf W. Karchmer, Jack L. LeFrock, Daniel P. Lew, Jon T. Mader, Carl Norden, and James S. Tan Medical Service, Veterans Affairs Puget Sound Health Care System, and Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington; Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, United Kingdom; Northern Michigan Infectious Diseases, Petoskey, Michigan; Section of Infectious Diseases, Department of Medicine, University of Manitoba, Winnipeg, Manitoba; Section of Podiatry, Department of Primary Care, Veterans Affairs Medical Center, Coatesville, Pennsylvania; Division of Infectious Diseases, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts; Dimensional Dosing Systems, Sarasota, Florida; Department of Medicine, Service of Infectious Diseases, University of Geneva Hospitals, Geneva, Switzerland; Department of Internal Medicine, The Marine Biomedical Institute, and Department of Orthopaedics and Rehabilitation, University of Texas Medical Branch, Galveston, Texas; Department of Medicine, New Jersey School of Medicine and Dentistry, and Cooper Hospital, Camden, New Jersey; and Department of Internal Medicine, Summa Health System, and Northeastern Ohio Universities College of Medicine, Akron, Ohio

Tumaini Nyamhanga, Veronica Masawe

Abstract Barriers to dog vaccination in Tanzania in general, and in Kilosa District in particular, are not well understood. Therefore, this study sought to address the following research question: What are the multilevel barriers to the vaccination of dogs against rabies in Kilosa District? Guided by a socioecological model, the study explored the barriers to dog vaccination at multiple levels within the Kilosa District context. A case study design employing a qualitative research approach was used. Data were collected through focus group discussions (FGDs) and in-depth interviews to investigate contextual barriers to dog vaccination. The collected data were analyzed using a thematic analysis approach. The results are organized according to the levels of the socioecological model. At the individual level, barriers include limited literacy about rabies and dog rabies vaccination; low perceived risk of rabies transmission; low prioritization of dog vaccination in household financial decisions; and uncertainty regarding the cost of dog vaccination. At the organizational/health system level, barriers include fragmented provision of rabies-related health education, reactive rather than proactive sensitization efforts, and limited communication channels, primarily relying on loudspeaker announcements. At the community level, barriers include misconceptions about protection against rabies and mistrust in political leadership. In conclusion, Rabies vaccination uptake in Kilosa District is constrained by multilevel barriers. Individually, limited knowledge, low risk perception, and financial uncertainty reduce prioritization of dog vaccination. Organizational barriers include fragmented health education, weak cross-sector coordination, and reactive communication. At the community level, logistical challenges, absence of By-Laws, persistent misconceptions, and political mistrust further limit vaccination coverage.

C. Greenaway, S. Hargreaves, S. Barkati et al.

COVID-19: Exposing and addressing health disparities among ethnic minorities and migrants Christina Greenaway, MD, MSc1,2,3,*, Sally Hargreaves, PhD4, Sapha Barkati, MD, MSc3,5, Christina M. Coyle, MD, MS6, Federico Gobbi, MD, PhD7, Apostolos Veizis, MD8 and Paul Douglas, MD9 1Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Canada, 2Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada, 3JD MacLean Centre for Tropical Diseases, McGill University Health Centre, McGill University, Montreal, Canada, 4Institute for Infection and Immunity, St George’s University of London, London, UK, 5Department of Medicine, Division of Infectious Diseases, McGill University Health Center, McGill University, Montreal, Canada, 6Department of Medicine, Division of Infectious Disease, Albert Einstein College of Medicine, Bronx, NY, USA, 7Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy, 8Médecins Sans Frontières, Athens, Greece and 9Migration Health Division, International Organization for Migration, Geneva, Switzerland

O. Tkacheva, Y. Kotovskaya, N. Runikhina et al.

The paper represents clinical guidelines on frailty, developed by Russian Association of gerontologists and geriatricians. The guidelines are dedicated to geriatricians, internal medicine specialists, general practitioners, family doctors and other specialists, dealing with adult patients. The paper includes screening and diagnostic tools and treatment options for patients with frailty, along with prevention, rehabilitation and medical care organization in this cohort of patients.

Marcel Parciak, Noëlla Pierlet, Liesbet M Peeters

Health data integration platforms are vital to drive collaborative, interdisciplinary medical research projects. Developing such a platform requires input from different stakeholders. Managing these stakeholders and steering platform development is challenging, and misaligning the platform to the partners’ strategies might lead to a low acceptance of the final platform. We present the medEmotion project, a collaborative effort among 7 partners from health care, academia, and industry to develop a health data integration platform for the region of Limburg in Belgium. We focus on the development process and stakeholder engagement, aiming to give practical advice for similar future efforts based on our reflections on medEmotion. We introduce Personas to paraphrase different roles that stakeholders take and Demonstrators that summarize personas’ requirements with respect to the platform. Both the personas and the demonstrators serve 2 purposes. First, they are used to define technical requirements for the medEmotion platform. Second, they represent a communication vehicle that simplifies discussions among all stakeholders. Based on the personas and demonstrators, we present the medEmotion platform based on components from the Microsoft Azure cloud. The demonstrators are based on real-world use cases and showcase the utility of the platform. We reflect on the development process of medEmotion and distill takeaway messages that will be helpful for future projects. Investing in community building, stakeholder engagement, and education is vital to building an ecosystem for a health data integration platform. Instead of academic-led projects, the health care providers themselves ideally drive collaboration among health care providers. The providers are best positioned to address hospital-specific requirements, while academics take a neutral mediator role. This also includes the ideation phase, where it is vital to ensure the involvement of all stakeholders. Finally, balancing innovation with implementation is key to developing an innovative yet sustainable health data integration platform.

Katharine Hopkins, Annarita Antelmi, Jakob Dahlin et al.

Fibromyalgia is a chronic syndrome characterized by pain, fatigue, and cognitive disturbances. The increased prevalence of contact allergy to gold in individuals with fibromyalgia when compared with the general population has previously been described. Gold contact allergy can manifest as a systemic contact dermatitis, with cutaneous and extracutaneous manifestations presenting upon systemic administration of gold. This study aimed to establish whether gold allergy is of significance in the fibromyalgia population. Prior to patch testing with the Swedish baseline series and an extended dental series, 119 females with fibromyalgia answered questionnaires including details of past medical history, dental history, and previous cutaneous and mucous membrane intolerance to metals. Prevalence of allergy to gold sodium thiosulphate (2.0% and 5.0%) was 33.6% (40 individuals). There was a statistically significant overrepresentation of gold allergy among individuals who experienced cutaneous symptoms upon direct contact with gold (p = 0.010). Contact allergy to gold was more frequent among patients with oral symptoms (p = 0.024). This study demonstrates concordance between reported cutaneous symptomatology related to gold exposure and gold allergy in the fibromyalgia population. Whether individuals with oral symptoms and gold allergy have objective oral clinical findings and relevant gold exposure is the focus of ongoing study.

Popovic DS, Koufakis T, Patoulias D et al.

Djordje S Popovic,1 Theocharis Koufakis,2 Dimitrios Patoulias,2 Anca Pantea Stoian,3 Nikolaos Papanas4 1Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia; 2Second Propaedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 3Department of Diabetes, Nutrition and Metabolic Diseases, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; 4Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, GreeceCorrespondence: Djordje S Popovic, Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Vojvodina, Medical Faculty, University of Novi Sad, Hajduk Veljkova 1, Novi Sad, 21000, Serbia, Tel +38163551606, Email pitstop021@gmail.com; djordje.popovic@mf.uns.ac.rsAbstract: Recreational diving with self-contained underwater breathing devices is gaining popularity worldwide as a sport and leisure activity. People living with type 1 diabetes mellitus (PLT1D) are no exception, although historically diabetes mellitus, especially insulin-treated, has been described as an absolute contra-indication for diving. However, based on observational data collected by the Divers Alert Network, the presence of background diabetes mellitus became only a relative contraindication for those without significant co-morbidities or long-term complications. Regarding diving activities among PLT1D, the primary concern is the risk of hypoglycaemia, especially in those with impaired awareness. Furthermore, symptoms consistent with hypoglycaemia could be confused with those originating from other factors related to diving. Although avoidance of hypoglycaemia is imperative among PLT1D practicing diving, the risk of severe hyperglycaemia should also be minimised. Continuous glucose monitoring (CGM) nowadays represents the standard of care for PLT1D, but its accuracy during diving activities is still a matter of debate. This commentary aims to summarize the existing data on accuracy, durability, and underwater performance of different CGM devices among PLT1D who engage in diving, and to call for additional research in the field. Based on available results, the application of real-time CGM still requires extreme caution since none of the existing systems has so far met the standards for accurate use in underwater conditions. Further improvements of contemporary CGM devices, validated through large-scale trials, are necessary before their widespread implementation among PLT1D practicing diving. Such advances should further enhance safety during this popular activity.Keywords: continuous glucose monitoring, diving, type 1 diabetes mellitus

Austin M Stroud, Sarah A Minteer, Xuan Zhu et al.

As health systems incorporate artificial intelligence (AI) into various aspects of patient care, there is growing interest in understanding how to ensure transparent and trustworthy implementation. However, little attention has been given to what information patients need about these technologies to promote transparency of their use. We conducted three asynchronous online focus groups with 42 patients across the United States discussing perspectives on their information needs for trust and uptake of AI, focusing on its use in cardiovascular care. Data were analyzed using a rapid content analysis approach. Our results suggest that patients have a set of core information needs, including specific information factors pertaining to the AI tool, oversight, and healthcare experience, that are relevant to calibrating trust as well as perspectives concerning information delivery, disclosure, consent, and physician AI use. Identifying patient information needs is a critical starting point for calibrating trust in healthcare AI systems and designing strategies for information delivery. These findings highlight the importance of patient-centered engagement when developing AI model documentation and communicating and provisioning information about these technologies in clinical encounters.

Caridad Sánchez Silot, Mayelyn Rodríguez Estenger, Nelsa María Sagaró Del Campo et al.

Introducción: La inmunoterapia específica con alérgenos consiste en administrar a la persona alérgica cantidades gradualmente crecientes de extracto alergénico, para reducir los síntomas asociados con la exposición a dicho alérgeno. Objetivo: Caracterizar a los pacientes pediátricos con enfermedades alérgicas que recibieron inmunoterapia con Valergen. Métodos: Se realizó un estudio descriptivo y transversal en 197 pacientes en edades pediátricas con enfermedades alérgicas, atendidos la consulta de Alergia del Hospital Pediátrico Sur “Dr. Antonio María Béguez Cesar” de Santiago de Cuba, en el periodo de enero 2018 a enero 2020. Se estimaron como medidas de resumen frecuencias absolutas y porcentajes y para la edad, la media y desviación estándar. Resultados: Predominaron los pacientes entre 9-13 años (47,7 %), el sexo masculino (51,8 %) y como enfermedad alérgica el asma 45,2 %. El 41,1 % de los pacientes, estuvieron sensibilizados al ácaro Dermatophagoides pteronyssius y se encontraban con edades entre nueve y trece años. Respecto al sexo, este mismo ácaro prevaleció en el masculino (41,6 %). Las vacunas más aplicadas fueron: Valergen-DP y la combinación de DP+BT (38,6 % y 20,8 %) respectivamente, donde la administración sublingual fue la más utilizada (86,3 %). Conclusiones: El asma y la rinitis alérgica constituyeron las enfermedades alérgicas más frecuentes en los pacientes pediátricos. Existió mayor sensibilización al ácaro Dermatophagoides pteronyssius y su combinación con el siboney; por lo que la inmunización con Valergen-DP y con DP+BT, por vía sublingual fueron las más aplicadas.

Jie Li, Yuhao Li, Xiaoyang Zhou et al.

Abstract Chronic inflammation in adipose tissue is widely recognized as a pivotal link connecting obesity to a spectrum of related chronic diseases, including type 2 diabetes, non-alcoholic fatty liver disease, and cardiovascular disorders. In this pathogenic process, the dysregulated interaction between adipocytes and adipose-resident immune cells plays a critical regulatory role; however, the underlying mechanisms governing this abnormal interaction remain largely unknown. In this study, we showed that upregulated β2-microglobulin expression in hypertrophic adipocytes during obesity not only mediated the activation of adipose-resident CD8+ T cells in a cell contact-dependent manner but also facilitated iron overload and the ferroptosis of adipocytes, thereby promoting the M1 polarization of adipose tissue macrophages. Conversely, specific ablation of β2-microglobulin in adipocytes effectively suppressed the activation and accumulation of adipose-resident CD8+ T cells, as well as adipocyte ferroptosis and M1 polarization, ultimately preventing high-fat diet-induced obesity and its related inflammation and metabolic disorders. Additionally, adeno-associated virus-mediated adipose-targeted knockdown of β2-microglobulin has been demonstrated to therapeutically alleviate high-fat diet-induced obesity, as well as its related chronic inflammation and metabolic disorders. Furthermore, our bioinformatic analysis of human adipose transcriptome data revealed a strong correlation between adipose β2-microglobulin and obesity. More importantly, β2-microglobulin is significantly upregulated in adipocytes isolated from patients with obesity. Thus, our findings highlight the pivotal role of adipocytes in obesity-associated chronic inflammation and metabolic disorders via β2-microglobulin-dependent mechanisms.

K. Maconochiea, Robert Binghamb, Christoph Eichc et al.

P. Rosen

A. Lobo, M. Pérez-Echeverría, J. Artal

Zihan Wang, Wei Xu, Yanlian Yang et al.

BackgroundWe sought to explore the impact of changing treatment strategy based on circulating tumor cells (CTC) on postoperative survival of breast cancer.MethodsWe retrospectively analyzed records of patients who underwent surgery for early-stage breast cancer at Beijing Friendship Hospital from January 2016 to January 2018 and regularly underwent CTC examination after surgery. During the regular examination and CTC monitoring, the patients with positive CTC results and without distant metastasis had their treatment regimen changed.ResultsOf 109 patients who received CTC examination regularly after surgery, 61 (56.0%) were CTC-positive during postoperative follow-up, including 33 ER or PR-positive, and 28 ER and PR-negative patients. Of the 33 ER or PR-positive patients, 20 changed endocrine therapy drugs. Compared with those without replacement, those with changed endocrine therapy strategy had higher CTC clearance rates (90.0% vs. 53.8%, p=0.04) and significantly lower CTC-positive values (1.70 ± 1.72 vs. 0.62 ± 0.65, p = 0.04). Among the 28 patients who were CTC positive and ER and PR-negative, 11 used capecitabine. Compared with non-users, the capecitabine users had higher CTC clearance rates (100.0% vs. 52.9%, p=0.01) and more significant decrease in CTC-positive values (2.09 ± 1.14 vs. 0.82 ± 1.67, p=0.04). Disease-free survival (DFS) at 1, 3, and 5 years was significantly longer in those who changed treatment than in those who did not (respectively, 96.6% vs. 89.6%, 92.8% vs. 56.9%, 69.0% vs. 47.8%, p<0.01). By changing the treatment strategy, CTC-positive patients achieved DFS that was not significantly different from CTC-negative patients (95.0% vs. 97.7%, 77.5% vs. 82.9%, 57.6% vs. 59.9%, p=0.20).ConclusionTimely change of treatment strategy for breast cancer patients with positive CTC results after surgery may improve CTC clearance rate and DFS.

Rahmat Ramazani, Fatemeh Mohammadi shir mahleh, Tahreh Ranjbaripour et al.

Introduction: This study aimed to compare the effectiveness of the emotion regulation method based on the Gross model and muscle relaxation technique on perceived stress, anxiety, and resilience in patients with coronary heart disease (CHD). Material & Methods: This study quasi-experimental study had a pretest-posttest design and follow-up and control groups. The statistical population included all patients in the age range of 30-50 years with coronary heart disease who were referred to medical centers and private cardiology clinics in Ilam, Iran, in 2020, of whom 60 people were selected using a random sampling method and divided into three groups by random distribution method. The data collection tools included standard scales of perceived stress, anxiety, and resilience. Findings: The results of repeated measures analysis of variance showed the effectiveness of Benson’s relaxation exercises on perceived stress, anxiety, and resilience as well as the effectiveness of emotion regulation training based on the Gross model on perceived stress and anxiety in patients. The comparison of the two treatment models showed that Benson’s relaxation exercises could reduce patients’ perceived stress and anxiety more effectively. However, emotion regulation training based on the Gross model has been more effective in increasing patients’ resilience than Benson’s relaxation exercises. Discussion & Conclusion: Based on the obtained results, emotion regulation training based on the Gross model and muscle relaxation exercises can be used as an effective intervention to complement medical treatment and improve patients' general health.

Jennifer L. Halford, Valerie N. Morrill, Seung Hoan Choi et al.

M. Berenbaum

Velia Penza, Stephen J. Russell, Autumn J. Schulze

Long polycytidine (polyC) tracts varying in length from 50 to 400 nucleotides were first described in the 5′-noncoding region (NCR) of genomes of picornaviruses belonging to the Cardio- and Aphthovirus genera over 50 years ago, but the molecular basis of their function is still unknown. Truncation or complete deletion of the polyC tracts in picornaviruses compromises virulence and pathogenicity but do not affect replicative fitness in vitro, suggesting a role as “viral security” RNA element. The evidence available suggests that the presence of a long polyC tract is required for replication in immune cells, which impacts viral distribution and targeting, and, consequently, pathogenic progression. Viral attenuation achieved by reduction of the polyC tract length has been successfully used for vaccine strategies. Further elucidation of the role of the polyC tract in viral replication cycle and its connection with replication in immune cells has the potential to expand the arsenal of tools in the fight against cancer in oncolytic virotherapy (OV). Here, we review the published data on the biological significance and mechanisms of action of the polyC tract in viral pathogenesis in Cardio- and Aphthoviruses.